Incidence of intraabdominal hypertension (IAH) and its impact on postoperative outcomes in adults undergoing living donor liver transplantation (LDLT)

Monitoring the effects of intra-abdominal hypertension (IAH) has been in practice in a variety of clinical situations, including postsurgical patients and critically ill patients, since its invention in the nineteenth century. The World Society of Abdominal Compartment Syndrome (WSACS) has defined IAH as an intraabdominal pressure (IAP) > 12 mmHg. They also classified IAH into 4 grades: Grade I: IAH of 12–15 mmHg; Grade II: IAH of 16–20 mmHg; Grade III: IAH of 21–25 mmHg; and Grade IV: IAH of >25 mmHg. Abdominal compartment syndrome (ACS) is defined as an IAP > 20 mmHg with evidence of organ failure. Previous studies have documented the adverse physiological effects of IAH on respiratory, hemodynamic, renal, and other visceral functions, thereby affecting postoperative outcome and increasing morbidity and mortality. Patients undergoingliving donor liver transplantation (LDLT) are also at risk of IAH due to their preoperative chronic liver disease state, frequent association with tense ascites, the complex nature of the transplant procedure, including the risk of intraperitoneal haemorrhages (surgical bleeding or coagulopathy-related), the use of perihepatic or retroperitoneal packs to control bleeding, bowel congestion due to portal hypertension, massive fluid and blood product administration, Therefore, it is important to monitor IAP in post-LDLT patients. Only 2-3 previous studies were found which showed an association between IAH and a complicated postoperative course after liver transplant in adults irrespective of type of donor. However, to the best of our knowledge, the effects of IAH have not been previously investigated in adult LDLT patients, particularly in Indian population. Through this prospective observational study, we aim to evaluate the incidence of IAH and its impact on postoperative outcome in adult LDLT patients. We will also investigate the possible adverse effects of IAH on renal, respiratory, cardiac, and graft function.